On Tuesday emergency care providers from two states and four agencies collaborated on a simulation to evaluate emergency care procedures and aid in training.

The effort, coordinated by the American College of Cardiology, involved the Cana Rescue Squad, Northern Hospital of Surry, Surry County Emergency Services and Forsyth Medical Center. Top officials with each agency were aware of the simulation before it took place, but the first responders and hospital staff were not aware.

Personnel with the American College of Cardiology stationed themselves at the Hungry Farmer Restaurant in Cana, Va., to stage the incident. They called in a report of cardiac arrest to emergency communications around 10 a.m. Cana Rescue promptly responded to the restaurant, all but the captain unaware of the simulation. They assessed the patient, a woman who acted out the scene, then they transported her to Northern Hospital. The patient was then sent to Forsyth Medical Center for more intense treatment.

Personnel with the American College of Cardiology followed the emergency personnel through the entire process, from the first responders to the physicians at Forsyth Medical Center. They filmed the process to use for training. They also evaluated each participating emergency care group from start to finish. They didn’t inform the responders of the simulations ahead of time so they could preserve realistic responses to the situation.

Jason Busick, captain of Cana Rescue, said of the simulation, “I think it’s going to be huge as far as pre-hospital care ... It shows how rural groups can get the same job done.”

Renee Easter, a member of Cana Rescue Squad, said, “I think it went excellent. For me it was a great practice, learning experience.”

She said working with the other agencies is key in ensuring the health and quick treatment of the patient. The simulation stressed to her again the importance of working together.

She said, “I always think there’s room for improvement. Like with assessment skills, you always need to be on your toes.”

Andrea Johnson, director of emergency services at Northern Hospital, said, “This was an excellent education opportunity. In addition, we got to show our expertise.”

Johnson said Northern Hospital treated the woman like a true STEMI or severe heart attack patient, sending her off to Forsyth for primary care within 17 minutes. She said that was an excellent time frame. The staff at the hospital was not warned about the simulation, but Johnson said they figured it out pretty quickly.

“But everybody responded just exactly as they would have normally,” Johnson remarked.

Surry County Emergency Services staff were responsible for transporting the patient to Forsyth. John Shelton, director of Surry County Emergency Services, hopes to use the video of the simulation on Tuesday to educate the public at lectures and speaking engagements.

“The benefit for us is public education,” said Shelton. “We already know the process, and the process works very well.”

Dr. John Patterson, medical director of the cardiac cath lab at Forsyth, said the simulation was good for evaluation purposes.

“There’s always opportunity for improvement,” said Patterson. He said improvements can be as minor as how to set up the table in the operating room.

The physician said there would be a sit-down overview Tuesday night with the staff to talk about how the simulation went. A written document will also be given later by the American College of Cardiology. The videotape of the simulation will be used for training at other sites.

With the simulation, Patterson said the patient had myocardial infarction with other complications. The physician said the actress gave a convincing performance. She was wearing a body suit. The hospital staff worked on a mannequin to perform the actual procedure of inflating a balloon in the chest and putting three stints in the artery.

“This is very routine,” Patterson said of the procedure. He said the medical center can get up to three to five patients with acute heart attacks in a day.

The protocols followed by the different agencies have been established by the Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments (RACE) project. The RACE project was created a few years ago in the state to increase the speed of coronary care. The statewide effort may expand nationwide in the future. The American College of Cardiology is a nationwide group that also focuses on cardiac care.

Through recent studies of hospitals across the state, the RACE project identified time frame protocols that need to be in place for emergency care providers. Shelton said his office has had special protocols in place for the past few years, and it has been enhanced in the past year.

Shelton said his office was contacted to know if officials there were interested in participating in the simulation and working on public outreach for STEMI protocol. The emergency services director said he is behind it 100 percent.

“The outcomes ... are excellent,” said Shelton.

The effort yesterday demonstrated how the protocols are supposed to work. Shelton said, “They were trying to show a full process.”

With the protocols, the time from the ER to Cath lab should be less than 90 minutes, Patterson said. Forsyth typically performs within the 64- to 67-minute range, he said.

“Every minute is crucial,” said Patterson.

Unfortunately, many people don’t get help immediately for cardiac symptoms. Busick said a lot of people think it’s just indigestion and wait a few hours before finally calling for help. Public education is helping improve that, though, Shelton said.

“Our biggest enemy is the economy,” Patterson said. He said many people are afraid they can’t pay for the treatment.

He continued, “With the economy the way it is, people are waiting around ... putting it off.”

Shelton said, “Don’t take a chance. The payment can be worked out in some fashion.”

Johnson said a person probably needs to call emergency services if they experience symptoms such as chest pain, pain radiating up through the face, shortness of breath, weakness, nausea, vomiting, discoloration, even pain in other areas such as the hand or abdomen.

Contact Meghann Evans at mevans@mtairynews.com or 719-1952.